I’m 80 years old, white, a lifelong resident of the Midwest, and a regular churchgoer. I am also a survivor of female genital mutilation/cutting (FGM/C).
Does this shock you? I imagine it does. But similar stories are happening on every continent except Antarctica every day, most often driven by deep-seated cultural beliefs about and fears of women’s sexuality and sexual pleasure. It’s not surprising that the doctor who cut me was a Seventh-day Adventist, a religion that has historically had strict prohibitions against masturbation.
These operations can lead to a lifetime of health issues (some of which I’ve suffered): frequent urinary tract infections, menstrual problems, infertility, pain during sexual intercourse, and difficulty giving birth. Too often the pain of this is compounded by inappropriate reactions from clinicians, including expressing disdain for the person’s culture, bringing others in to view the altered genitalia without permission, and failing to listen to what the patient says she needs — particularly patients who are coming in for obstetric care.
This is something that I and other organizations are working to change. I share my story yearly with second-year students at the Mayo Clinic Alix School of Medicine in Rochester, Minnesota and Scottsdale, Arizona. Students are always surprised that this happened to a little white girl in Midwest America and continues today in some extremely conservative evangelical Christian churches. I inform them of my interactions with physicians at various stages of my life and how the situations could have been handled more sensitively and professionally, involving me in the care of my body.
I begin with my history of being cut by a doctor who practiced his religion with a scalpel. Then I talk about my three children’s births. When the first, my daughter, was born, my scar tissue did not stretch, so my daughter and I could have died if a caring obstetrician had not done an extensive episiotomy. However, I felt I was not fully treated as a partner in the birthing decisions.
My goal in sharing my stories is not to horrify, but to educate budding physicians in how they can partner with women in their practices who have undergone these procedures. Because positioning in stirrups on an exam table can lead to reliving the trauma of being cut, a physician needs to be open to delaying an exam until trust is developed. The women may not realize that their medical issues are related to the cut — or even know that they were cut if it happened when they were very young.
In some cultures, being cut is believed to help with childbirth when, in reality, narrowing the vaginal opening makes childbirth much more difficult. Doctors who don’t know how to address a body that’s been cut sometimes go right to an unnecessary cesarean section when, rather than a major surgery, opening the scar can ease delivery and alleviate issues after healing.
With the assistance of Filsan Nur Ali, a young Somali woman who is also an FGM/C survivor, I created a brochure written in both English and Somali for pregnant women to give to their clinicians early in their pregnancy to plan for labor and delivery. We address the culturally positive intent of the cut as well as the consequences now that the woman is giving birth.
In total, we’ve distributed 1,800 brochures, and have shared digital files with several organizations so they could print as needed. We’re working to scale up our initiative further, and we’re continuing to share stories with medical students to help spread this vital knowledge. I talk to 100 medical students a year, but so many more could be reached by finding ways to formalize this kind of communication.
When women undergo FGM/C, their decision-making power is stripped from them, even when it is part of a culture or belief system. By educating physicians and their patients about how they can partner in their healthcare, particularly in childbirth, those women are getting back a little of their power — and the medical professional is embracing the whole patient and practicing medicine with the compassion that they have sworn to offer. It’s time that more doctors were given the chance to learn how to do that.
A. Renée Bergstrom, EdD, is a Public Voices fellow on Advancing the Rights of Women and Girls with The OpEd Project and Equality Now.
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